JP2014531277A - Patient temperature control catheter with spiral heat exchange path - Google Patents

Patient temperature control catheter with spiral heat exchange path Download PDF

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JP2014531277A
JP2014531277A JP2014533602A JP2014533602A JP2014531277A JP 2014531277 A JP2014531277 A JP 2014531277A JP 2014533602 A JP2014533602 A JP 2014533602A JP 2014533602 A JP2014533602 A JP 2014533602A JP 2014531277 A JP2014531277 A JP 2014531277A
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path
working fluid
catheter
spiral
heat exchange
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リチャード エー. ヘルコウスキー
リチャード エー. ヘルコウスキー
ジェレミー ティー. ダブロウィアク
ジェレミー ティー. ダブロウィアク
ヴェンカタ ヴィシュヌ グルクラ
ヴェンカタ ヴィシュヌ グルクラ
アレックス エル. リム
アレックス エル. リム
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Zoll Circulation Inc
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F7/00Heating or cooling appliances for medical or therapeutic treatment of the human body
    • A61F7/12Devices for heating or cooling internal body cavities
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00831Material properties
    • A61B2017/00867Material properties shape memory effect
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F7/00Heating or cooling appliances for medical or therapeutic treatment of the human body
    • A61F7/12Devices for heating or cooling internal body cavities
    • A61F2007/126Devices for heating or cooling internal body cavities for invasive application, e.g. for introducing into blood vessels

Abstract

カテーテル(10等)は、作動流体のソースと通じる作動流体供給経路を含む。カテーテルは、また、作動流体供給経路から作動流体のソースへ作動流体を戻すために、作動流体供給経路と通じる作動流体戻り経路を含む。作動流体供給経路及び作動流体戻り経路の少なくとも1つは、カテーテルの遠位熱交換領域(48;64;80;96)に含まれ、遠位熱交換領域は、第1の螺旋経路及び第2の螺旋経路(50,52;66,68;82,84;98,100)を含み、かつ形状記憶材料からなる。【選択図】図1The catheter (such as 10) includes a working fluid supply path that communicates with a source of working fluid. The catheter also includes a working fluid return path that communicates with the working fluid supply path to return the working fluid from the working fluid supply path to the source of working fluid. At least one of the working fluid supply path and the working fluid return path is included in the distal heat exchange region (48; 64; 80; 96) of the catheter, the distal heat exchange region comprising the first helical path and the second Of spiral paths (50, 52; 66, 68; 82, 84; 98, 100) and made of a shape memory material. [Selection] Figure 1

Description

本願は、一般的な患者の温度制御システムに関する。   The present application relates to a general patient temperature control system.

脳卒中又は心臓発作又は心停止により生じた深刻な脳外傷又は虚血を患う患者のための医学的成果は、患者が正常体温(37°C)を下回って冷却される場合に、向上されていることが見出されている。さらに、このような患者にとっては、たとえ低体温症を誘発しないと決定されていたとしても、高体温(発熱)を防ぐことが重要であることも認められている。また、冠状動脈バイパス手術後の外科処置のような特定の用途では、低体温症の患者を温め直すことが望まれている。   Medical outcomes for patients suffering from severe brain trauma or ischemia caused by a stroke or heart attack or cardiac arrest are improved when the patient is cooled below normal body temperature (37 ° C) It has been found. Furthermore, it has also been recognized that for such patients it is important to prevent hyperthermia (fever) even if it has been determined not to induce hypothermia. Also, in certain applications, such as surgical procedures after coronary artery bypass surgery, it is desirable to reheat patients with hypothermia.

本願により理解されるように、温度を調整することの上記の利点は、カテーテルを通じて生理食塩水のような作動流体を循環し、カテーテルと接続される外部熱交換器において適切に作動流体を加熱又は冷却する患者の静脈系に配置される閉ループ熱交換カテーテルを用いて患者の身体全体を冷却又は加熱することにより実現されることができる。以下の米国特許文献は、その全てが参照により本明細書に援用され、そのような目的のための様々な血管内のカテーテル/システム/方法を開示する:米国特許6,881,551及び6,585,692(トリ−ローベカテーテル)、6,551,349及び6,554,797(ベローズを有するカテーテル)、6,749,625及び6,796,995(非直線、非螺旋状熱交換素子を有するカテーテル)、6,126,684,6,299,599,6,368,304及び6,338,727(複数の熱交換バルーンを有するカテーテル)、6,146,411,6,019,783,6,581,403,7,287,398及び5,837,003(カテーテル用の熱交換システム)、7,857,781(様々な熱交換カテーテル)。   As will be understood by the present application, the above advantages of adjusting the temperature circulate a working fluid such as saline through the catheter and appropriately heat or heat the working fluid in an external heat exchanger connected to the catheter. It can be achieved by cooling or heating the entire patient's body using a closed loop heat exchange catheter placed in the patient's venous system to be cooled. The following US patent documents are hereby incorporated by reference in their entirety and disclose various endovascular catheters / systems / methods for such purposes: US Pat. Nos. 6,881,551 and 6, 585,692 (tri-lobe catheter), 6,551,349 and 6,554,797 (catheter with bellows), 6,749,625 and 6,796,995 (non-linear, non-helical heat exchange elements) 6, 126, 684, 6, 299, 599, 6, 368, 304 and 6,338, 727 (catheter having multiple heat exchange balloons), 6, 146, 411, 6, 019, 783 6,581,403,7,287,398 and 5,837,003 (heat exchange system for catheters), 7,857,781 (various heat exchange capacities) Ether).

したがって、カテーテルは、作動流体のソースと通じる作動流体供給経路と、前記作動流体供給経路から前記作動流体のソースへ前記作動流体を戻すために、前記作動流体供給経路と通じる作動流体戻り経路と、を備える。前記作動流体供給経路及び/又は前記作動流体戻り経路の少なくとも1つは、前記カテーテルの遠位熱交換領域に含まれ、前記遠位熱交換領域は、患者に配置される。前記遠位熱交換領域は、第1の螺旋経路及び第2の螺旋経路を含み、かつ形状記憶材料からなってもよい。制限されない実施形態では、前記形状記憶材料は、ニチノールであってもよい。   Thus, the catheter has a working fluid supply path that communicates with a source of working fluid, and a working fluid return path that communicates with the working fluid supply path to return the working fluid from the working fluid supply path to the source of working fluid. Is provided. At least one of the working fluid supply path and / or the working fluid return path is included in a distal heat exchange region of the catheter, and the distal heat exchange region is disposed on a patient. The distal heat exchange region may include a first spiral path and a second spiral path and may be made of a shape memory material. In a non-limiting embodiment, the shape memory material may be nitinol.

また、本明細書で説明される螺旋経路は、制限されない実施形態において、二重螺旋構造を実現するために、互いに重複してもよい、又はそれらは、別の制限されない実施形態において、互いに重複しなくてもよい。必要に応じて、前記第1の螺旋経路は、前記作動流体供給経路にあってもよく、又は前記第1及び第2の螺旋経路の両方は、前記作動流体供給経路にあってもよい。それに替えて、前記第1の螺旋経路は、制限されない実施形態において、前記作動流体戻り経路にあってもよく、又は前記第1及び第2の螺旋経路は、さらに別の制限されない実施形態において、作動流体戻り経路にあってもよい。   Also, the helical paths described herein may overlap each other to achieve a double helical structure in a non-limiting embodiment, or they overlap each other in another non-limiting embodiment. You don't have to. Optionally, the first helical path may be in the working fluid supply path, or both the first and second helical paths may be in the working fluid supply path. Alternatively, the first spiral path may be in the working fluid return path in an unrestricted embodiment, or the first and second spiral paths are in yet another unrestricted embodiment. It may be in the working fluid return path.

別の態様では、方法は、少なくとも部分的にカテーテルを規定し、かつ作動流体のソースと通じる作動流体供給経路を提供することを含む。前記方法は、また、前記作動流体供給経路から前記作動流体のソースへ前記作動流体を戻すために、少なくとも部分的に前記カテーテルを規定し、かつ前記作動流体供給経路と通じる作動流体戻り経路を提供することを含む。本明細書で開示される方法により提供される前記経路の少なくとも1つは、前記カテーテルの遠位熱交換領域に含まれ、前記遠位熱交換領域は、第1及び第2の螺旋経路を含む。   In another aspect, the method includes providing a working fluid supply path that at least partially defines a catheter and communicates with a source of working fluid. The method also provides a working fluid return path that at least partially defines the catheter and communicates with the working fluid supply path to return the working fluid from the working fluid supply path to the source of working fluid. Including doing. At least one of the pathways provided by the methods disclosed herein is included in a distal heat exchange region of the catheter, and the distal heat exchange region includes first and second helical pathways. .

さらに別の態様では、カテーテルは、作動流体のソースと通じる作動流体供給経路と、前記作動流体供給経路から前記作動流体のソースへ前記作動流体を戻すために、前記作動流体供給経路と通じる作動流体戻り経路と、を備える。前記供給及び/又は戻り経路の少なくとも1つは、前記カテーテルの熱交換領域に含まれ、前記熱交換領域は、患者に位置付けられる。前記熱交換領域は、複数の螺旋経路を含み、前記複数の螺旋経路は、2つの螺旋経路のみに限定されないと理解される。   In yet another aspect, the catheter has a working fluid supply path that communicates with a source of working fluid and a working fluid that communicates with the working fluid supply path to return the working fluid from the working fluid supply path to the source of working fluid. A return path. At least one of the supply and / or return paths is included in a heat exchange area of the catheter, and the heat exchange area is positioned on a patient. It is understood that the heat exchange region includes a plurality of spiral paths, and the plurality of spiral paths is not limited to only two spiral paths.

本発明の詳細は、その構造及び動作の両方共に、添付の図面を参照しながら最も良く理解することができ、参照番号は、部品等を示す。   The details of the invention, both its structure and operation, can best be understood with reference to the accompanying drawings, in which reference numerals indicate parts and the like.

図1は、熱交換システムの一例と係合されたカテーテルの一例を示す概要図である。FIG. 1 is a schematic diagram illustrating an example of a catheter engaged with an example of a heat exchange system. 図2は、互いに重複しない一般的な円筒螺旋経路を有するカテーテルの概要図である。FIG. 2 is a schematic diagram of a catheter having a general cylindrical spiral path that does not overlap each other. 図3は、二重螺旋構造を実現するために、互いに重複する一般的な円筒螺旋経路を有するカテーテルの概要図である。FIG. 3 is a schematic diagram of a catheter having typical cylindrical helical paths that overlap each other to achieve a double helical structure. 図4は、互いに重複しない一般的な円錐螺旋経路を有するカテーテルの概要図である。FIG. 4 is a schematic diagram of a catheter having general conical spiral paths that do not overlap each other. 図5は、二重螺旋構造を実現するために、互いに重複する一般的な円錐螺旋経路を有するカテーテルの概要図である。FIG. 5 is a schematic view of catheters having general conical helical paths that overlap each other to achieve a double helical structure. 図6は、一般的な高次螺旋構造を実現する螺旋経路を有するカテーテルの概要図である。FIG. 6 is a schematic view of a catheter having a spiral path that realizes a general higher-order spiral structure. 図7は、最も冷たい冷却材がカテーテルの最も遠い部分へ繰り返し伝搬されることを確実にするために、螺旋戻り管の軸と平行であるが、同軸上にない直線供給経路管を有するカテーテルの別の実施形態を示す。FIG. 7 shows a catheter having a straight supply path tube that is parallel to the axis of the helical return tube but not coaxial to ensure that the coldest coolant is repeatedly propagated to the farthest portion of the catheter. Another embodiment is shown. 図8は、最も冷たい冷却材がカテーテルの最も遠い部分へ繰り返し伝搬されることを確実にするために、螺旋戻り管の軸と平行かつ同軸上にある直線供給管を有するカテーテルの別の実施形態を示す。FIG. 8 illustrates another embodiment of a catheter having a straight supply tube that is parallel and coaxial with the axis of the helical return tube to ensure that the coldest coolant is repeatedly propagated to the farthest portion of the catheter. Indicates.

先ず、図1を参照すると、血管内温度管理カテーテル10は、本原理に係るロジックを実行するプロセッサを含むカテーテル温度管理システム12と流体連通しており、本明細書で参照する特許文献の一又はそれ以上で説明されるように、患者のコア温度フィードバック信号に応答する処置パラダイムに基づいてカテーテル10を通じて循環する作動流体の温度を制御する。本原理によれば、カテーテル10は、これに限定されないが、生理食塩水のような冷却材が、体内に侵入しないように閉ループで循環するカテーテルを用いて患者に低体温療法を誘導するために使用されることができる。このような処置は、脳卒中、心停止(蘇生後)、急性心筋梗塞、脊髄損傷及び外傷性脳損傷のために示されてもよい。カテーテル10は、例えば、バイパス手術又は火傷処置の後の患者を温めるためにも用いられることができ、例えば、くも膜下出血又は脳内出血を患う患者の高体温と戦うためにも用いられることができる。   Referring first to FIG. 1, an intravascular temperature management catheter 10 is in fluid communication with a catheter temperature management system 12 that includes a processor that performs logic in accordance with the present principles. As described further above, the temperature of the working fluid circulating through the catheter 10 is controlled based on a treatment paradigm responsive to the patient's core temperature feedback signal. In accordance with the present principles, the catheter 10 is not limited to this, in order to guide the patient to hypothermia using a catheter that circulates in a closed loop so that a coolant such as saline does not enter the body. Can be used. Such treatment may be indicated for stroke, cardiac arrest (post-resuscitation), acute myocardial infarction, spinal cord injury and traumatic brain injury. The catheter 10 can also be used, for example, to warm a patient after a bypass surgery or burn procedure, and can also be used, for example, to combat the hyperthermia of a patient suffering from subarachnoid or intracerebral hemorrhage. .

図示されるように、作動流体は、図示されるようなカテーテル10の近位端に接続する供給及び戻りライン16,18を通じて熱交換システム12とカテーテル10との間を循環してもよい。なお、ここで用いられるカテーテルに関する“近位”及び“遠位”は、システム12に対するものである。カテーテル‐ボーン(catheter−borne)温度センサからの患者の温度信号は、電線路20又は所望される場合、無線を通じてシステム10に提供されてもよい。それに替えて、患者の温度信号は、患者の温度を測定する別の食道プローブ、直腸プローブ、鼓膜センサ、膀胱プローブ、又は他の温度プローブからシステム12に提供されてもよい。   As shown, the working fluid may circulate between the heat exchange system 12 and the catheter 10 through supply and return lines 16, 18 that connect to the proximal end of the catheter 10 as shown. It should be noted that “proximal” and “distal” with respect to the catheter used herein are relative to the system 12. A patient temperature signal from a catheter-bone temperature sensor may be provided to the system 10 via the electrical line 20 or, if desired, wirelessly. Alternatively, the patient temperature signal may be provided to the system 12 from another esophageal probe, rectal probe, tympanic sensor, bladder probe, or other temperature probe that measures the patient's temperature.

カテーテル10は、作動流体が循環される内部供給回収ルーメンに加えて、薬剤を患者に注入するためのシリンジ又はIVバッグのようなIV構成要素22と接続可能な1つ又はそれ以上の注入ルーメン又は患者のパラメータ等をモニターする酸素又は圧力モニター器具を有してもよい。   Catheter 10 may include one or more infusion lumens connectable to an IV component 22 such as a syringe or IV bag for injecting medication into a patient in addition to an internal supply and recovery lumen through which working fluid is circulated. You may have an oxygen or pressure monitoring device to monitor patient parameters and the like.

カテーテル10は、通常、患者14の血管系(vasculature)に位置付けられており、鼠径部挿入位置を介した下大静脈又は首(頸部又は鎖骨下)挿入位置を介した上大静脈のような患者14の静脈系に位置付けられることが好ましい。   The catheter 10 is typically positioned in the vasculature of the patient 14, such as the inferior vena cava via the groin insertion position or the superior vena cava via the neck (neck or subclavian) insertion position. It is preferably located in the venous system of patient 14.

次に、図2−6については、図1を参照して説明した例示的なカテーテルの特定の態様及び/又は構成要素は、明確化のために図2−6では省略されるが、これらの態様及び/又は構成要素は、制限されない実施形態では、図2−6を参照して説明されるカテーテルにも存在することが理解される。例えば、図1を参照して説明されたIV構成要素、温度センサ、及び電気配線は、図2−6では示されないが、これらも存在している。   2-6, certain aspects and / or components of the exemplary catheter described with reference to FIG. 1 are omitted in FIG. 2-6 for clarity, but these It will be appreciated that aspects and / or components may also be present in the catheter described with reference to FIGS. 2-6 in non-limiting embodiments. For example, the IV components, temperature sensors, and electrical wiring described with reference to FIG. 1 are not shown in FIGS. 2-6, but are also present.

ここで、具体的に図2を参照して、互いに重複しない通常の円筒状の螺旋経路を有することが示されるカテーテルが示される。より具体的には、カテーテル24は、図2に示される熱交換システム30のような、本原理に係る、作動流体のソースと通じる作動流体供給経路26を有する。カテーテル24は、また、供給経路26から熱交換システム30へ作動流体を戻すために、作動流体供給経路26と流体連通する作動流体戻り経路28も有する。   Referring now specifically to FIG. 2, there is shown a catheter that is shown to have normal cylindrical helical paths that do not overlap each other. More specifically, the catheter 24 has a working fluid supply path 26 that communicates with a source of working fluid according to the present principles, such as the heat exchange system 30 shown in FIG. The catheter 24 also has a working fluid return path 28 that is in fluid communication with the working fluid supply path 26 to return the working fluid from the supply path 26 to the heat exchange system 30.

カテーテル24は、また、患者38のような患者に位置付けられてもよい遠位熱交換領域32を有し、経路26及び/又は28の少なくとも1つは、カテーテル24の遠位熱交換領域32に含まれる。さらに、遠位熱交換領域32は、互いに流体連通する第1の螺旋経路34及び第2の螺旋経路36を含んでもよい。図2に示される制限されない実施形態では、それぞれが作動流体供給経路及び作動流体戻り経路である経路34及び36は、中央に位置しないような遠位熱交換領域32を実質的に含み、螺旋又はねじれ形状で形成される側面を有する直線管を有する場合であるときにカテーテル24の軸に沿って延びる一般的な直線ボディを含む。すなわち、経路34,36を通じる作動流体の流れは、螺旋経路に経路が形成される。   Catheter 24 also has a distal heat exchange region 32 that may be positioned in a patient, such as patient 38, and at least one of pathways 26 and / or 28 is in distal heat exchange region 32 of catheter 24. included. Further, the distal heat exchange region 32 may include a first helical path 34 and a second helical path 36 that are in fluid communication with each other. In the non-limiting embodiment shown in FIG. 2, paths 34 and 36, each of which is a working fluid supply path and a working fluid return path, substantially includes a distal heat exchange region 32 that is not centrally located, It includes a general straight body that extends along the axis of the catheter 24 when it has a straight tube with sides formed in a twisted shape. That is, the flow of the working fluid through the paths 34 and 36 forms a path in a spiral path.

制限されない実施形態では、図2に示される遠位熱交換領域32は、図3−6を参照して説明される他の遠位熱交換領域と同様に、ニチノールのような形状記憶材料からなってもよいが、これに限定されない。しかし、例えば、カテーテルが、カテーテルが位置付けられる患者の一部の表面領域に対する角度で患者に侵入するとき、図2−6のカテーテルが、簡単に患者に位置付けられるように、本明細書に開示されるような熱交換領域は、制限されない実施形態におけるフレキシブル及び/又はしなやかであってもよいことが理解される。それに替えて、他の制限されない実施形態では、熱交換領域32は、必要に応じて、リジッドであってもよい。   In a non-limiting embodiment, the distal heat exchange region 32 shown in FIG. 2 is made of a shape memory material such as nitinol, as are the other distal heat exchange regions described with reference to FIGS. 3-6. However, it is not limited to this. However, for example, when the catheter enters the patient at an angle to the surface area of the portion of the patient where the catheter is positioned, the catheter of FIGS. 2-6 is disclosed herein so that it can be easily positioned on the patient. It will be appreciated that such heat exchange regions may be flexible and / or compliant in non-limiting embodiments. Alternatively, in other non-limiting embodiments, the heat exchange region 32 may be rigid as desired.

図2を参照し、かつ上述したように、第1の螺旋経路34は、供給経路26の少なくとも一部にある、及び/又は供給経路26の少なくとも一部を規定する。また、制限されない実施形態では、第2の螺旋経路36は、戻り経路28の少なくとも一部にある、及び/又は戻り経路28の少なくとも一部を規定する。第1の螺旋経路34及び第2の螺旋経路36は、互いに重複しないことが図2から理解される。さらに、図2に示されるような螺旋経路34及び36は、通常、円筒状であると理解されるが、螺旋経路34及び36は、本原理によれば、円筒形状及び/又は対称である必要はない。   With reference to FIG. 2 and as described above, the first helical path 34 is at least part of and / or defines at least part of the supply path 26. Also, in a non-limiting embodiment, the second helical path 36 is at least part of the return path 28 and / or defines at least part of the return path 28. It can be seen from FIG. 2 that the first spiral path 34 and the second spiral path 36 do not overlap each other. Further, although spiral paths 34 and 36 as shown in FIG. 2 are generally understood to be cylindrical, spiral paths 34 and 36 need to be cylindrical and / or symmetrical according to the present principles. There is no.

また、制限されない実施形態では、図2の第1及び第2の螺旋経路(と共に以下に説明される図3−6の第1及び第2の螺旋経路)の両方は、別の戻り経路が流体を熱交換システムへ戻すように作動流体供給経路にあってもよく、又は別の供給経路が熱交換システムから図示しない流体を供給するように作動流体戻り経路にあってもよいことが理解される。さらに制限されない実施形態では、図2−6の第1の螺旋経路は、作動流体戻り経路にあり、図2−6の第2の螺旋経路は、作動流体供給経路にあってもよいことがさらに理解される。すなわち、本明細書に説明されるような第1及び第2の経路間の流体連通の複数の制限されない構成及び作動流体のソースは、本原理に基づいて提供されてもよい。   Also, in a non-limiting embodiment, both the first and second spiral paths of FIG. 2 (as well as the first and second spiral paths of FIGS. 3-6 described below) are separate return paths for fluids. It will be appreciated that the working fluid supply path may be in a return to the heat exchange system, or another supply path may be in the working fluid return path to supply a fluid (not shown) from the heat exchange system. . In a further non-limiting embodiment, the first helical path of FIGS. 2-6 may be in the working fluid return path and the second helical path of FIGS. 2-6 may be in the working fluid supply path Understood. That is, a plurality of non-limiting configurations of fluid communication between the first and second paths as described herein and a source of working fluid may be provided in accordance with the present principles.

螺旋経路が形状記憶材料からなる実施形態では、それらは、例えば、患者への挿入及び回収のために、放射状に小さい構成、又は真っ直ぐであり、非螺旋であり、並んだ(side−by−side)構成のような収縮した構成に変形されてもよい。そして、患者内では、経路は、血液との熱交換を最大にするためにそれらの拡大した螺旋形状を取るように解放されてもよい。この構成の変化に影響を与えるために加熱が用いられてもよく、又はカテーテルは、遠位端の出口での経路が、それらがバイアスされる形状に螺旋形状を取ると、シースの内側にフィットするために経路を限定し、それらを充分に小さい構成に変形する導入シースを通じて単に患者へ侵入されてもよい。   In embodiments in which the spiral path consists of shape memory material, they are, for example, for insertion and retrieval into a patient, a radially small configuration, or straight, non-spiral, side-by-side. ) It may be transformed into a contracted configuration like the configuration. And within the patient, pathways may be released to take their expanded helical shape to maximize heat exchange with blood. Heating may be used to affect this configuration change, or the catheter will fit inside the sheath as the path at the outlet of the distal end takes a helical shape to the shape in which they are biased. In order to do so, it may simply be entered into the patient through an introducer sheath that limits the path and transforms them into a sufficiently small configuration.

ここで、図3を参照すると、二重螺旋構造を実現するために互いに重複する一般的な円筒螺旋形状を有するカテーテルが示される。よって、カテーテル40は、図3に示される熱交換システム46のような、本原理に係る作動流体のソースと通じる作動流体供給経路42を有する。カテーテル40は、また、供給経路42から熱交換システム46へ作動流体を戻すために、作動流体供給経路42と流体連通する作動流体戻り経路44を有する。   Referring now to FIG. 3, a catheter having a general cylindrical helical shape that overlaps each other to achieve a double helical structure is shown. Thus, the catheter 40 has a working fluid supply path 42 that communicates with a source of working fluid according to the present principles, such as the heat exchange system 46 shown in FIG. The catheter 40 also has a working fluid return path 44 that is in fluid communication with the working fluid supply path 42 to return the working fluid from the supply path 42 to the heat exchange system 46.

カテーテル40は、また、患者54のような患者内に位置付けられる遠位熱交換領域48を有し、経路42及び/又は44の少なくとも1つは、カテーテル40の遠位熱交換領域48に含まれる。さらに、遠位熱交換領域48は、明確化のために、図3に示される2つの螺旋経路のみを通じた、複数の螺旋経路を含んでもよいことが理解される。したがって、図3は、互いに流体連通する第1の螺旋経路50及び第2の螺旋経路52を示す。図3に示されるような螺旋経路50及び螺旋経路52は、通常円筒形状であると理解されるが、螺旋経路50及び螺旋経路52は、本原理によれば、円筒形状及び/又は対称的である必要はないことが理解される。   Catheter 40 also has a distal heat exchange region 48 positioned within a patient, such as patient 54, and at least one of pathways 42 and / or 44 is included in distal heat exchange region 48 of catheter 40. . Furthermore, it is understood that the distal heat exchange region 48 may include multiple helical paths through only the two helical paths shown in FIG. 3 for clarity. Accordingly, FIG. 3 shows a first spiral path 50 and a second spiral path 52 in fluid communication with each other. Although spiral path 50 and spiral path 52 as shown in FIG. 3 are generally understood to be cylindrical, spiral path 50 and spiral path 52 are cylindrical and / or symmetrical according to the present principles. It will be understood that there need not be.

図3に示される制限されない実施形態では、第1の螺旋経路50は、供給経路42の少なくとも一部にある、及び/又は供給経路42の少なくとも一部を規定する。また、制限されない実施形態では、第2の螺旋経路52は、戻り経路44の少なくとも一部にある、及び/又は戻り経路44の少なくとも一部を規定する。図3からは、第1の螺旋経路50及び第2の螺旋経路52が、カテーテル40の軸に沿って二重螺旋構造を実現するために互いに重複し、二重螺旋構造は、通常円筒形状であることがわかる。実質的に、経路50,52は、互いに同軸上にある。   In the non-limiting embodiment shown in FIG. 3, the first helical path 50 is at least part of the supply path 42 and / or defines at least part of the supply path 42. Also, in a non-limiting embodiment, the second helical path 52 is at least part of the return path 44 and / or defines at least part of the return path 44. From FIG. 3, the first helical path 50 and the second helical path 52 overlap each other to achieve a double helical structure along the axis of the catheter 40, the double helical structure having a generally cylindrical shape. I know that there is. Substantially, the paths 50 and 52 are coaxial with each other.

図4に移ると、互いに重複しない一般的な円錐形状螺旋経路を有するカテーテルが示される。よって、カテーテル56は、図4に示される熱交換システム62のような、本原理に係る作動流体のソースと通じる作動流体供給経路58を有する。カテーテル56は、また、供給経路58から熱交換システム62へ作動流体を戻すために、作動流体供給経路58と流体連通する作動流体戻り経路60を有する。   Turning to FIG. 4, a catheter having a general conical spiral path that does not overlap each other is shown. Thus, the catheter 56 has a working fluid supply path 58 that communicates with a source of working fluid according to the present principles, such as the heat exchange system 62 shown in FIG. The catheter 56 also has a working fluid return path 60 in fluid communication with the working fluid supply path 58 to return the working fluid from the supply path 58 to the heat exchange system 62.

カテーテル56は、また、本原理に係る遠位熱交換領域64を有し、これは、患者70のような患者内に位置付けられてもよい。領域64は、互いに流体連通する第1の螺旋経路66及び第2の螺旋経路68を含む。図4に示されるように、螺旋経路66及び68は、通常円錐形状であると理解されるが、円錐螺旋経路66は、本原理によれば、対称的である必要はない。   Catheter 56 also has a distal heat exchange region 64 according to the present principles, which may be positioned within a patient, such as patient 70. Region 64 includes a first spiral path 66 and a second spiral path 68 that are in fluid communication with each other. As shown in FIG. 4, the helical paths 66 and 68 are understood to be normally conical, but the conical helical paths 66 need not be symmetrical according to the present principles.

また、本原理によれば、第1の螺旋経路66は、制限されない実施形態の供給経路58の少なくとも一部にある、及び/又は供給経路58の少なくとも一部を規定する。また、制限されない実施形態では、第2の螺旋経路68は、戻り経路60の少なくとも一部である、及び/又は戻り経路60の少なくとも一部を規定する。図4からわかるように、通常の円錐螺旋経路66及び68は、互いに重複しない。   Also, according to the present principles, the first spiral path 66 is at least part of and / or defines at least part of the supply path 58 of the non-limiting embodiment. Also, in a non-limiting embodiment, the second helical path 68 is at least part of the return path 60 and / or defines at least part of the return path 60. As can be seen from FIG. 4, the normal conical spiral paths 66 and 68 do not overlap each other.

図5は、また、通常の円錐螺旋経路を有するカテーテルを示すが、図5では、通常の円錐螺旋経路は、二重螺旋構造を実現するために、互いに重複する。よって、カテーテル72は、図5に示される熱交換システム78のような、本原理に係る作動流体のソースと通じる作動流体供給経路74を有する。カテーテル72は、また、供給経路74から熱交換システム78へ作動流体を戻すために、作動流体供給経路74に流体連通する作動流体戻り経路76を有する。   FIG. 5 also shows a catheter having a normal conical spiral path, but in FIG. 5, the normal conical spiral paths overlap each other to achieve a double helical structure. Thus, the catheter 72 has a working fluid supply path 74 that communicates with a source of working fluid according to the present principles, such as the heat exchange system 78 shown in FIG. The catheter 72 also has a working fluid return path 76 that is in fluid communication with the working fluid supply path 74 to return the working fluid from the supply path 74 to the heat exchange system 78.

カテーテル72は、また、本原理に係る遠位熱交換領域80を有し、これは、患者86のような患者内に位置付けられてもよい。図5からわかるように、カテーテル72の領域80は、互いに流体連通する第1の螺旋経路82及び第2の螺旋経路84を含む。さらに、螺旋経路82及び84は、通常円錐形状であると理解されるが、螺旋経路82及び84は、本原理によれば、対称的である必要はない。   Catheter 72 also has a distal heat exchange region 80 in accordance with the present principles, which may be positioned within a patient, such as patient 86. As can be seen from FIG. 5, the region 80 of the catheter 72 includes a first spiral path 82 and a second spiral path 84 that are in fluid communication with each other. Furthermore, although spiral paths 82 and 84 are understood to be generally conical, spiral paths 82 and 84 need not be symmetrical according to the present principles.

また、本原理によれば、第1の螺旋経路82は、制限されない実施形態において、供給経路74の少なくとも一部にある、及び/又は供給経路74の少なくとも一部を定義する。また、制限されない実施形態では、第2の螺旋経路84は、戻り経路76の少なくとも一部にある、及び/又は戻り経路76の少なくとも一部を定義する。図5からわかるように、通常の円錐螺旋経路82及び84は、カテーテル72の軸に沿って二重螺旋構造を実現するために互いに重複する。   Also, according to the present principles, the first helical path 82 is in at least a portion of the supply path 74 and / or defines at least a portion of the supply path 74 in a non-limiting embodiment. Also, in a non-limiting embodiment, the second helical path 84 is at least part of the return path 76 and / or defines at least part of the return path 76. As can be seen from FIG. 5, the normal conical helical paths 82 and 84 overlap each other to achieve a double helical structure along the axis of the catheter 72.

ここで図6を参照すると、一般的な高次螺旋構造を実現する螺旋経路を有するカテーテルが示される。よって、カテーテル88は、図6に示される熱交換システム94のような、本原理に係る作動流体のソースと通じる作動流体供給経路90を有する。カテーテル88は、また、供給経路90から熱交換システム94へ作動流体を戻すために、作動流体供給経路90に流体連通する作動流体戻り経路92を有する。   Referring now to FIG. 6, a catheter having a helical path that implements a typical higher order helical structure is shown. Thus, the catheter 88 has a working fluid supply path 90 that communicates with a source of working fluid according to the present principles, such as the heat exchange system 94 shown in FIG. The catheter 88 also has a working fluid return path 92 that is in fluid communication with the working fluid supply path 90 to return the working fluid from the supply path 90 to the heat exchange system 94.

カテーテル88は、また、本原理に係る遠位熱交換領域96を有し、これは、患者102のような患者内に位置付けられてもよい。図6からわかるように、カテーテル88の領域96は、互いに流体連通する第1の螺旋経路98及び第2の螺旋経路100を含む。図6に示されるように、螺旋経路98及び100は、通常、円錐形状であると理解されるが、螺旋経路98及び100は、本原理によれば、円錐形状及び/又は対称的である必要はない。   Catheter 88 also has a distal heat exchange region 96 according to the present principles, which may be positioned within a patient, such as patient 102. As can be seen in FIG. 6, the region 96 of the catheter 88 includes a first helical path 98 and a second helical path 100 in fluid communication with each other. As shown in FIG. 6, although the spiral paths 98 and 100 are generally understood to be conical, the spiral paths 98 and 100 need to be conical and / or symmetric according to the present principles. There is no.

図6からは、螺旋経路98及び100は、遠位熱交換領域96での高次螺旋構造を実現するために巻かれている。本明細書で理解されるように、高次螺旋(superhelix)(及び図6に示される一般的な高次螺旋構造)は、螺旋状に巻かれている複数の螺旋であると理解されることを留意する。さらに、経路98及び100は、概略的な図で示される各螺旋アウトライン104により囲まれているが、アウトライン104は、経路98及び100により実現される高次螺旋構造を示すために、視覚的な目的としてのみ提供されることを留意する。   From FIG. 6, the helical paths 98 and 100 are wound to achieve a higher order helical structure at the distal heat exchange region 96. As understood herein, a higher order helix (and the general higher order helical structure shown in FIG. 6) is understood to be a plurality of spirals wound in a spiral. Keep in mind. Further, the paths 98 and 100 are surrounded by each spiral outline 104 shown in the schematic diagram, but the outline 104 is visually shown to show the higher order spiral structure realized by the paths 98 and 100. Note that it is provided only for purposes.

図6をさらに参照すると、第1の螺旋経路98は、制限されない実施形態において供給経路90の少なくとも一部にある、及び/又は供給経路90の少なくとも一部を規定する。また、制限されない実施形態では、第2の螺旋経路100は、戻り経路92の少なくとも一部にある、及び/又は戻り経路92の少なくとも一部を規定する。よって、図6からわかるように、それぞれが螺旋構造を有する螺旋経路98及び100は、一般的な高次螺旋構造を実現するために巻かれている。   With further reference to FIG. 6, the first helical path 98 is in at least a portion of the supply path 90 and / or defines at least a portion of the supply path 90 in a non-limiting embodiment. Also, in a non-limiting embodiment, the second helical path 100 is at least part of the return path 92 and / or defines at least part of the return path 92. Accordingly, as can be seen from FIG. 6, the spiral paths 98 and 100 each having a spiral structure are wound to realize a general higher-order spiral structure.

図7に移ると、リニア(直線)作動流体供給経路及び一般的な螺旋作動流体戻り経路を有するカテーテルが示される。図7を参照して説明されるようなリニア作動流体供給経路は、上述したような、カテーテルを通じて延びる一般的なリニアボディとは混同されない。よって、カテーテル106は、図7に示されるような熱交換システム112のような本原理に係る作動流体のソースと通じる作動流体供給経路108を有する。カテーテル106は、また、供給経路108から熱交換システム112へ作動流体を戻すために、作動流体供給経路108に流体連通する作動流体戻り経路110を有する。   Turning to FIG. 7, a catheter having a linear working fluid supply path and a general helical working fluid return path is shown. The linear working fluid supply path as described with reference to FIG. 7 is not confused with the general linear body that extends through the catheter, as described above. Thus, the catheter 106 has a working fluid supply path 108 that communicates with a source of working fluid according to the present principles, such as a heat exchange system 112 as shown in FIG. The catheter 106 also has a working fluid return path 110 that is in fluid communication with the working fluid supply path 108 to return the working fluid from the supply path 108 to the heat exchange system 112.

カテーテル106は、また、本原理に係る遠位熱交換領域114を有し、これは、患者120のような患者内に位置付けられてもよい。領域114は、互いに流体連通する一般的な直線経路116及び螺旋戻り経路118を含む。図7に示されるように、螺旋経路118は、通常の螺旋形状であることができ、本原理に係る円錐形状又は円錐螺旋形状であってもよい。   Catheter 106 also has a distal heat exchange region 114 according to the present principles, which may be positioned within a patient, such as patient 120. Region 114 includes a general straight path 116 and a spiral return path 118 that are in fluid communication with each other. As shown in FIG. 7, the spiral path 118 can be a regular spiral shape, and may be a conical shape or a conical spiral shape according to the present principles.

また、本原理によれば、直線経路116は、遠位領域114の少なくとも一部を規定すると理解され、示される例示の実施形態では、供給経路108の少なくとも一部にある、及び/又は供給経路108の少なくとも一部を規定する。また、図7に示される例のように、螺旋経路118は、遠位領域114の少なくとも一部を規定すると理解され、かつ、戻り経路110の少なくとも一部である、及び/又は戻り経路110の少なくとも一部を規定する。図7からわかるように、経路116及び118は、互いに重複しない。供給経路は、螺旋戻り経路の軸と平行であるが、これは同軸上にはない。   Also, according to the present principles, the straight path 116 is understood to define at least a portion of the distal region 114, and in the exemplary embodiment shown, is at least a portion of the supply path 108 and / or the supply path. At least a part of 108 is defined. Also, as in the example shown in FIG. 7, the helical path 118 is understood to define at least a portion of the distal region 114 and is at least part of the return path 110 and / or of the return path 110. Specify at least a part. As can be seen from FIG. 7, the paths 116 and 118 do not overlap each other. The feed path is parallel to the axis of the spiral return path, but it is not coaxial.

ここで図8を参照すると、一般的な螺旋作動流体戻り経路と重複する直線作動流体供給経路の概略図が示される。図8を参照して説明されるような一般的な直線作動流体供給経路は、上述したような、カテーテルを通じて延びる一般的な直線ボディとは混同されないことを留意する。よって、カテーテル122は、図8に示されるような熱交換システム128のような、本原理に係る作動流体のソースと通じる作動流体供給経路124を有する。カテーテル122は、また、供給経路124から熱交換システム128へ作動流体を戻すために、作動流体供給経路124に流体連通する作動流体戻り経路126を有する。   Referring now to FIG. 8, a schematic diagram of a linear working fluid supply path that overlaps with a typical helical working fluid return path is shown. Note that the general linear working fluid supply path as described with reference to FIG. 8 is not confused with the general linear body extending through the catheter, as described above. Thus, the catheter 122 has a working fluid supply path 124 that communicates with a source of working fluid according to the present principles, such as a heat exchange system 128 as shown in FIG. The catheter 122 also has a working fluid return path 126 that is in fluid communication with the working fluid supply path 124 to return the working fluid from the supply path 124 to the heat exchange system 128.

カテーテル122は、また、本原理に係る遠位熱交換領域130を有し、これは、患者136のような患者内に位置付けられてもよい。領域130は、螺旋戻り経路134を通じて通常中央に延びる一般的な直線経路132を含み、経路132及び134は、互いに流体連通する。図8に示されるように、螺旋経路134は、一般的な螺旋形状であると理解され、本原理によれば、円錐形状又は円錐形状であってもよい。   The catheter 122 also has a distal heat exchange region 130 according to the present principles, which may be positioned within a patient, such as the patient 136. Region 130 includes a general straight path 132 that typically extends centrally through a helical return path 134, and paths 132 and 134 are in fluid communication with each other. As shown in FIG. 8, the spiral path 134 is understood to be a general spiral shape and may be conical or conical in accordance with the present principles.

また、本原理によれば、一般的な直線経路132は、示される例示的な実施形態において、供給経路124の少なくとも一部にある、及び/又は供給経路124の少なくとも一部を規定する。また、図8に示されるような例示的な実施形態では、螺旋経路134は、戻り経路126の少なくとも一部にある、及び/又は戻り経路126の少なくとも一部を規定する。図8に示されるような例示的な実施形態からわかるように、経路132及び134は、一般的な直線経路132が、螺旋経路134を通じて延びるように、互いに重複する。供給経路は、螺旋戻り経路の軸と平行であり、かつ同軸上にある。   Also, in accordance with the present principles, the general straight path 132 is in at least a portion of the supply path 124 and / or defines at least a portion of the supply path 124 in the illustrated exemplary embodiment. Also, in the exemplary embodiment as shown in FIG. 8, the helical path 134 is at least part of the return path 126 and / or defines at least part of the return path 126. As can be seen from the exemplary embodiment as shown in FIG. 8, the paths 132 and 134 overlap each other such that a general straight path 132 extends through the helical path 134. The supply path is parallel to the axis of the spiral return path and is coaxial.

ここで、上述した別の実施形態は、例えば、患者の血液を冷却するために患者の静脈に配置されるとき、患者の血液と接触するカテーテルの遠位端でのより大きな表面積を提供することが図2−8からわかる。本明細書で説明される実施形態は、また、カテーテルの遠位端により血液接触及び通過のときの良好な血液混合を提供することができることがさらに理解される。よって、患者の血液流は、例えば、カテーテルの増大した表面積と接触するときに静脈でその経路を変化させ、それにより、血液の混合を促進させ、熱伝達効率を増大させる。   Here, another embodiment described above provides a larger surface area at the distal end of the catheter that contacts the patient's blood, for example when placed in a patient's vein to cool the patient's blood. Can be seen from FIG. It is further understood that the embodiments described herein can also provide good blood mixing upon blood contact and passage through the distal end of the catheter. Thus, the patient's blood flow, for example, changes its path in the vein when in contact with the increased surface area of the catheter, thereby facilitating blood mixing and increasing heat transfer efficiency.

螺旋熱交換経路を有する患者の温度制御カテーテルについて本明細書で詳細が示され、説明されたが、本願発明により包含される内容は、特許請求の範囲によってのみ限定されることが理解される。   Although details have been shown and described herein for a patient temperature control catheter having a spiral heat exchange path, it is understood that the subject matter encompassed by the present invention is limited only by the claims.

Claims (20)

カテーテルであって、
作動流体のソースと通じる作動流体供給経路と、
前記作動流体供給経路から前記作動流体のソースへ前記作動流体を戻すために、前記作動流体供給経路と通じる作動流体戻り経路と、を備え、
前記作動流体供給経路及び前記作動流体戻り経路の少なくとも1つは、前記カテーテルの遠位熱交換領域に含まれ、前記遠位熱交換領域は、第1の螺旋経路及び第2の螺旋経路を含み、かつ形状記憶材料からなる、カテーテル。
A catheter,
A working fluid supply path leading to a source of working fluid;
A working fluid return path that communicates with the working fluid supply path to return the working fluid from the working fluid supply path to the source of the working fluid;
At least one of the working fluid supply path and the working fluid return path is included in a distal heat exchange region of the catheter, and the distal heat exchange region includes a first spiral path and a second spiral path. A catheter made of a shape memory material.
前記形状記憶材料は、ニチノールである請求項1に記載のカテーテル。   The catheter of claim 1, wherein the shape memory material is nitinol. 前記第1の螺旋経路及び前記第2の螺旋経路は、二重螺旋構造を実現するために互いに重複する請求項1に記載のカテーテル。   The catheter of claim 1, wherein the first helical path and the second helical path overlap each other to achieve a double helical structure. 前記第1の螺旋経路及び前記第2の螺旋経路は、互いに重複しない請求項1に記載のカテーテル。   The catheter according to claim 1, wherein the first spiral path and the second spiral path do not overlap each other. 前記第1の螺旋経路は、前記作動流体供給経路にある請求項1に記載のカテーテル。   The catheter according to claim 1, wherein the first spiral path is in the working fluid supply path. 前記第1の螺旋経路及び前記第2の螺旋経路は、前記作動流体供給経路にある請求項1に記載のカテーテル。   The catheter according to claim 1, wherein the first spiral path and the second spiral path are in the working fluid supply path. 前記第1の螺旋経路は、前記作動流体戻り経路にある請求項1に記載のカテーテル。   The catheter of claim 1, wherein the first spiral path is in the working fluid return path. 前記第1の螺旋経路及び前記第2の螺旋経路は、前記作動流体戻り経路にある請求項1に記載のカテーテル。   The catheter of claim 1, wherein the first spiral path and the second spiral path are in the working fluid return path. 方法であって、
少なくとも部分的にカテーテルを規定し、かつ作動流体のソースと通じる作動流体供給経路を提供することと、
前記作動流体供給経路から前記作動流体のソースへ前記作動流体を戻すために、少なくとも部分的に前記カテーテルを規定し、かつ前記作動流体供給経路と通じる作動流体戻り経路を提供することと、を含み、
前記作動流体供給経路及び前記作動流体戻り経路の少なくとも1つは、前記カテーテルの遠位熱交換領域に含まれ、前記遠位熱交換領域は、第1の螺旋経路及び第2の螺旋経路を含む、方法。
A method,
Providing a working fluid supply path that at least partially defines a catheter and communicates with a source of working fluid;
Providing a working fluid return path at least partially defining the catheter and communicating with the working fluid supply path to return the working fluid from the working fluid supply path to the source of the working fluid. ,
At least one of the working fluid supply path and the working fluid return path is included in a distal heat exchange region of the catheter, and the distal heat exchange region includes a first spiral path and a second spiral path. ,Method.
前記遠位熱交換領域は、形状記憶材料からなる請求項9に記載の方法。   The method of claim 9, wherein the distal heat exchange region comprises a shape memory material. 前記第1の螺旋経路及び前記第2の螺旋経路は、二重螺旋構造を実現するために互いに重複する請求項9に記載の方法。   The method of claim 9, wherein the first helical path and the second helical path overlap each other to achieve a double helical structure. 前記第1の螺旋経路及び前記第2の螺旋経路は、互いに重複しない請求項9に記載の方法。   The method of claim 9, wherein the first spiral path and the second spiral path do not overlap each other. 前記第1の螺旋経路は、前記作動流体供給経路にある請求項9に記載の方法。   The method of claim 9, wherein the first spiral path is in the working fluid supply path. 前記第1の螺旋経路及び前記第2の螺旋経路は、前記作動流体供給経路にある請求項9に記載の方法。   The method of claim 9, wherein the first spiral path and the second spiral path are in the working fluid supply path. 前記第1の螺旋経路は、前記作動流体戻り経路にある請求項9に記載の方法。   The method of claim 9, wherein the first spiral path is in the working fluid return path. 前記第1の螺旋経路及び前記第2の螺旋経路は、前記作動流体戻り経路にある請求項9に記載の方法。   The method of claim 9, wherein the first spiral path and the second spiral path are in the working fluid return path. カテーテルであって、
作動流体のソースと通じる作動流体供給経路と、
前記作動流体供給経路から前記作動流体のソースへ前記作動流体を戻すために、前記作動流体供給経路と通じる作動流体戻り経路と、を備え、
前記作動流体供給経路及び前記作動流体戻り経路の少なくとも1つは、前記カテーテルの熱交換領域に含まれ、前記熱交換領域は、複数の螺旋経路を含む、カテーテル。
A catheter,
A working fluid supply path leading to a source of working fluid;
A working fluid return path that communicates with the working fluid supply path to return the working fluid from the working fluid supply path to the source of the working fluid;
At least one of the working fluid supply path and the working fluid return path is included in a heat exchange area of the catheter, and the heat exchange area includes a plurality of spiral paths.
前記螺旋経路は、高次螺旋を実現する請求項17に記載のカテーテル。   The catheter according to claim 17, wherein the spiral path realizes a higher order spiral. 前記螺旋経路は、円筒状である請求項17に記載のカテーテル。   The catheter according to claim 17, wherein the spiral path is cylindrical. 前記螺旋経路は、円錐形状である請求項17に記載のカテーテル。   The catheter of claim 17, wherein the helical path is conical.
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